Cardiac arrest: survival: cancer and infection predicted a poor outcome

Clinical bottom line (level 2b)

  1. In-patients who survived a cardiac arrest were at increased risk of dying if they had
    • poor functional status
    • serum creatinine >130 µ mol/l
    • cancer (particularly if metastatic)
    • sepsis
    • pneumonia
  2. In-patients who survived a cardiac arrest were more likely to survive if they had a myocardial infarction.
Ebell : Journal of Family Practice 1992; 34 (5): 551-558
Expires October 2003

The study

Systematic review of prognostic studies of
  • Patients: in-hospital surviving a cardiac arrest (on adult or intensive care wards)
  • Outcome: survival to discharge


    • Articles found in English using MEDline, 1980 to 1991 (search terms: resuscitation, survival and 1980-1991 ) and searching of bibliographies of relevant studies and author's personal reference files

    Selection criteria: see above
    Appraisal criteria: detailed in text
    Articles excluded if: any of
    • out-of-hospital cardiac arrest
    • specific diagnoses or rhythms
    • pediatric resuscitation


    14 studies found involving 2643 patients; mean age 59 to 79. 7 studies were prospective, none were blinded
    No test for heterogeneity noted.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death ? 2285/2643 87%
    (85% to 88%)

    prognostic factor for
    death     		time to outcome control rate (%) unadjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    serum creatinine >130 µ g ? 233/292
    (79.8%)     		5.44
    (2.72 to 10.9)     		6
    (6 to 9)
    dependent functional status ? 523/650
    (80.5%)     		4.99
    (2.92 to 8.55)     		7
    (6 to 8)
    metastatic cancer ? 797/923
    (86.3%)     		44.9
    (9.53 to 212)     		7
    (7 to 8)
    sepsis ? 904/1065
    (84.9%)     		6.86
    (2.51 to 18.8)     		8
    (7 to 12)
    pneumonia ? 977/1183
    (82.6%)     		2.86
    (1.43 to 5.72)     		9
    (7 to 22)
    cancer ? 1141/1356
    (84.1%)     		3.08
    (1.82 to 5.20)     		10
    (8 to 15)
    myocardial infarction ? 430/505
    (85.1%)     		0.53
    (0.36 to 0.79)     		-10
    (-31 to -6)

    Comments

    1. These prognostic factors need to be prospectively validated in an independent set of patients.

    Citation

    1. Ebell M, : Best predictors of survival following in-hospital cardiopulmonary resuscitation: a meta-analysis. Journal of Family Practice 1992; 34 (5): 551-558
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer:

    Clinical Question.
    Patient surviving a cardiac arrest
    Intervention or Exposure prognostic factors
    Outcome survival